Trouble Underfoot

Shoes and Schizophrenia

A closer look at a medical research report

by Bertha Vanatian

Do shoes cause schizophrenia? Jarl Flensmark of Malmo wants to know, and in a recent paper in the journal Medical Hypotheses, he explains why.
“Heeled footwear,” he writes,” began to be used more than a 1000 years ago, and led to the occurrence of the first cases of schizophrenia. ... Industrialization of shoe production increased schizophrenia prevalence. Mechanization of the production started in Massachusetts, spread from there to England and Germany, and then to the rest of Western Europe. A remarkable increase in schizophrenia prevalence followed the same pattern.”
The story, if accurate and true, is disturbing. Flensmark sketches the details:
“The oldest depiction of a heeled shoe comes from Mesopotamia, and in this part of the world we also find the first institutions making provisions for mental disorders. ... In the beginning schizophrenia appears to be more common in the upper classes. Possible early victims were King Richard II and Henry VI of England, his grandfather Charles VI of France, his mother Jeanne de Bourbon, and his uncle Louis II de Bourbon, Erik XIV of Sweden, Juana of Castile [and] her grandmother Isabella of Portugal.” All of these individuals are either known or suspected of wearing heeled shoes.
He cites evidence from other parts of the world, too -- Turkey, Taiwan, the Balkans, Ireland, Italy, Ghana, Greenland, the Caribbean, and elsewhere.
“Probably the upper classes began using heeled footwear earlier than the lower classes,” Flensmark points out. He then cites studies from India and elsewhere, which seem to confirm that “schizophrenia first affects the upper classes.”

From these two streams of evidence -- the rise of heels and the increase in documented cases of schizophrenia, Flensmark divines a strong connection. He modestly implies that he is not first to do so. In the year 1740, he writes, “the Danish-French anatomist Jakob Winslow warned against the wearing of heeled shoes, expecting it to be the cause of certain infirmities which appear not to have any relation to it.”
Flensmark boils the matter into a damning statement: “After heeled shoes is [sic] introduced into a population the first cases of schizophrenia appear and then the increase in prevalence of schizophrenia follows the increase in use of heeled shoes with some delay.”
“I have,” he writes, “not been able to find any contradictory data.”
Lest critics dismiss this as mere hand-waving or foot-tapping, Flensmark explains, biomedically, how the one probably causes the other:
“During walking synchronised stimuli from mechanoreceptors in the lower extremities increase activity in cerebellothalamo- cortico-cerebellar loops through their action on NMDA-receptors. Using heeled shoes leads to weaker stimulation of the loops. Reduced cortical activity changes dopaminergic function which involves the basal gangliathalamo- cortical-nigro-basal ganglia loops.”
Once could conclude that the medical establishment enjoys Flensmark’s discovery. Virtually no one has stepped up to dispute it.

These guys may look crazy, but they are U.S. soldiers, running a race in high heels for charity.